Posts Tagged ‘Dialyse’

Kontrastmittel

Donnerstag, 08. August 2013

Kontrastmittel_Praxisempfehlungen 2019!!!!

KMGraviditaet1

 

 

 

 

Kontrastmittel induzierte Nephropathie(CIN):

As for all the patients, we determined urine pH an hour before coronarography. Patients randomized to the citrate group received the Na/K citrate
solution (Uralyt U, Madaus granulat, Germany) (hexakalium–hexanatrium–trihydrogen–pentacitrat), a dose of 5 g of granules diluted in 200 mL of water.
We again measured urine pH immediately before coronary angiography, i.e. 1 h after the administration of the medicine. Four hours after the
administration of the first dose, the patients took another dose of the same medicine with standard hydration. Patients randomized to placebo received
twice 200 mL of water instead of Na/K with standard hydration. Both patients and investigators were unaware of treatment assignment, but patients and
examiners could have become aware of the difference between colour and taste of the hydration solution.
All patients with an eGFR <60 mL/min/1.73 m2 were hydrated with i.v. normal saline at a rate of 1 mL/kg/h for 2 h before and 12 h after coronary
angiography. Patients with an eGFR >60 mL/min/1.73 m2 were hydrated with oral hydration, i.e. at least 2000 mL of water starting 2 h before coronary angiography. The rate of infusion was reduced in patients who developed signs of pulmonary congestion. All additional infusions were strongly
discouraged and initiated only if indicated for other reasons. Additional oral fluid intake was encouraged in all groups.

UralytPreventionCIN

KM_Praevention

Prävention mit Bicarbonat ist auch möglich. Z.B. 8,4% Bicarbonatlsg 150 ml.

mit 1000 ml Nacl 0,8% verdünnt, davon 200ml vor Km geben über 1 Std.,beginn

1Std. vor der Untersuchung.Nach der Untersuchung 200ml über 4 Std.

Eine respiratorische Azidose

sollte ausgeschlossen sein. Erster Hinweis könnte eine verminderte Sauerstoffsättigung liefern

Spo2 < 94%. Standartbicarbonat >= 26 mmol/l. pco2> 44 mmHg

 

Urin ph Normalbereich 4,8 bis 7,6.(Mittel 6).

Theophyllin und ACC kann in Erwägung gezogen werden.

 

 

 

kombinierter-zeitnaher-einsatz-jod–und-gadoliniumhaltiger-kontmittel-in-der-diagnostischen-und-interventionellen-radiologie nephrogene-systemische-fibrose-nsfhttp://www.ultravist.ch/de/ultravist/dosierung/index.php

ESUR-Richtlinien 2007        

2008

Leitliniekontrastmittel


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